• Journal of Korean Neurosurgical Society
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• v.53 no.5
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• pp.288-292
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• 2013

Objective : Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF. Methods : This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 $kgf{\cdot}cm$) and the low torque group (distraction force${\leq}6kgf{\cdot}cm$) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months. Results : The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days ($y=0.99{\times}-1.1$, $r^2=0.82$; $y=0.77{\times}-0.63$, $r^2=0.73$, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively ($3.1{\pm}1.3$, $2.6{\pm}1.0$ compared with $6.0{\pm}0.6$, $4.9{\pm}0.8$, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods. Conclusion : Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 $kgf{\cdot}cm$.

• Journal of Korean Neurosurgical Society
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• v.37 no.2
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• pp.89-95
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• 2005

Objective: The biomechanical stabilities between the anterior plate fixation after anterior discectomy and fusion (ACDFP) and the posterior transpedicular fixation after ACDF(ACDFTP) have not been compared using human cadaver in bilateral cervical facet dislocation. The purpose of this study is to compare the stability of ACDFP, a posterior wiring procedure after ACDFP(ACDFPW), and ACDFTP for treatment of bilateral cervical facet dislocation. Methods: Ten human spines (C3-T1) were tested in the following sequence: the intact state, after ACDFP(Group 1), ACDFPW(Group 2), and ACDFTP(Group 3). Intervertebral motions were measured by a video-based motion capture system. The range of motion(ROM) and neutral zone(NZ) were compared for each loading mode to a maximum of 2.0Nm. Results: ROMs for Group 1 were below that of the intact spine in all loading modes, with statistical significance in flexion and extension, but NZs were decreased in flexion and extension and slightly increased in bending and axial rotation without significances. Group 2 produced additional stability in axial rotation of ROM and in flexion of NZ than Group 1 with significance. Group 3 provided better stability than Group 1 in bending and axial rotation, and better stability than Group 2 in bending of both ROM and NZ. There was no significant difference in extension modes for the three Groups. Conclusion: ACDFTP(Group 3) demonstrates the most effective stabilization followed by ACDFPW(Group 2), and ACDFP(Group 1). ACDFP provides sufficient strength in most loading modes, ACDFP can provide an effective stabilization for bilateral cervical facet dislocation with a brace.

• Journal of the Korean Orthopaedic Association
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• v.56 no.6
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• pp.512-518
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• 2021

Purpose: This study compared the change in foraminal space on magnetic resonance imaging (MRI) and the clinical outcome after anterior cervical discectomy and fusion (ACDF) versus foraminotomy in cervical foraminal stenosis. Materials and Methods: A retrospective case-control study was conducted from January 2018 to March 2019 on 186 patients who underwent ACDF and foraminotomy. One hundred and two cases were selected considering age, sex, and body mass index. MRI was performed before and on the 5^th day after surgery to compare the changes in the foraminal diameter between the ACDF group (group A-51) and foraminotomy group (group B-51). Results: Between groups A and B, the average change in foraminal vertical diameter was 1.7 mm and 1.2 mm, respectively; group A was 0.5 mm larger difference (p=0.042). The average change in foraminal transverse diameter was 1.2 mm and 1.8mm, respectively; group B showed a 0.6 mm larger change (p=0.21). Both the neck disability index (NDI) and Japanese orthopaedic association (JOA) scores improved in both groups. Group A showed more improvement, but there was no significant difference (p=0.356, p=0.607, respectively). Conclusion: Foraminotomy is a useful option for patients with foraminal stenosis of the cervical spine because it showed comparable clinical and morphological results to ACDF and could minimize motion segment loss and muscle and ligament damage.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.96-106
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• 2022

Objective : The most common complication of anterior cervical discectomy and fusion (ACDF) is cage subsidence and maintenance of disc height affects postoperative clinical outcomes. We considered cage subsidence as an inappropriate indicator for evaluating preservation of disc height. Thus, this study aimed to consider patients with complications such as reduced total disc height compared to that before surgery and evaluate the relevance of several factors before ACDF. Methods : We retrospectively reviewed the medical records of 40 patients who underwent stand-alone single-level ACDF using a polyetheretherketone (PEEK) cage at our institution between January 2012 and December 2018. Our study population comprised 19 male and 21 female patients aged 24-70 years. The minimum follow-up period was 1 year. Twenty-seven patients had preoperative bone mineral density (BMD) data on dual-energy X-ray absorptiometry. Clinical parameters included sex, age, body mass index, smoking history, and prior medical history. Radiologic parameters included the C2-7 cobb angle, segmental angle, sagittal vertical axis, disc height, and total intervertebral height (TIH) at the preoperative and postoperative periods. Cage decrement was defined as the reduction in TIH at the 6-month follow-up compared to preoperative TIH. To evaluate the bone quality, Hounsfield unit (HU) value was calculated in the axial and sagittal images of conventional computed tomography. Results : Lumbar BMD values and cervical HU values were significantly correlated (r=0.733, p<0.001). We divided the patients into two groups based on cage decrement, and 47.5% of the total patients were regarded as cage decrement. There were statistically significant differences in the parameters of measuring the HU value of the vertebra and intraoperative distraction between the two groups. Using these identified factors, we performed a receiver operating characteristic (ROC) curve analysis. Based on the ROC curve, the cut-off point was 530 at the HU value of the upper cortical and cancellous vertebrae (p=0.014; area under the curve [AUC], 0.727; sensitivity, 94.7%; specificity, 42.9%) and 22.41 at intraoperative distraction (p=0.017; AUC, 0.722; sensitivity, 85.7%; specificity, 57.9%). Using this value, we converted these parameters into a bifurcated variable and assessed the multinomial regression analysis to evaluate the risk factors for cage decrement in ACDF. Intraoperative distraction and HU value of the upper vertebral body were independent factors of postoperative subsidence. Conclusion : Insufficient intraoperative distraction and low HU value showed a strong relationship with postoperative intervertebral height reduction following single stand-alone PEEK cage ACDF.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.600-604
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• 2001

Objective : The authors report the microsurgical anterolateral tunnel approach for the treatment of the cervical disc diseases and its postoperative surgical results. Methods : All surgical procedures followed the method of classical microsurgical anterior discectomy. Small tunnel(7-8mm) was made on the disc space reaching to the posterior longitudinal ligament. The disc materials and bony spurs were removed through this tunnel. Thirty-one patients of cervical disc herniation(24 cases with pure disc herniation, 7 cases with combined cervical spondylosis) were evaluated on the symptoms, conformation in plain X-ray, C-T, and MRI. The follow up time was over 2 years. Results : Postoperatively the result(following the out come scale) was excellent and good in Twenty-nine patients. One with fair result showed remnant disc particle and spur and another one is combined with cord contusion. One patient with lesion in C 3-4 space and two cervicothoracic junction showed excellent result. Two patients with osteoporosis also showed good results. Cervical spine curvature and disc space height were not changed on the plain X-ray and MRI in all patients. Twenty-nine patients were discharged within 3 days after surgery without any postoperative complications. Conclusions : The microsurgical anterolateral tunnel approach could be indicated for the treatment of patients with cervical disc diseases and with difficulty in achieving interbody fusion(the higher cervical level and cervicothoracic junction, osteoporosis etc.).

• Journal of Korean Neurosurgical Society
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• v.61 no.5
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• pp.600-607
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• 2018

Objective : It has been reported in recent studies that 50-80% of patients with cervical disc hernia have concomitant sleep disorders. The aim of this study was to evaluate the quality of sleep before and after surgical treatment in patients with cervical disc hernia and to assess the effects on treatment. Methods : The study included 32 patients performed discectomy and fusion with an intervertebral cage through the right anterior cervical approach. Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) were applied to all patients preoperatively and at one month postoperatively. Results : The postoperative PSQI total points and all the PSQI subscale points, the ODI and VAS scores were significantly reduced compared to the preoperative values. A positive correlation was determined between the preoperative ODI points and the PSQI total points and sleep duration, sleep latency and daytime functional loss subscale points. A positive correlation was also found between preoperative ODI points and VAS points. A positive correlation was determined between the preoperative VAS points and and the PSQI total points and sleep duration, and sleep latency subscale points. A negative correlation was determined between the postoperative ODI and the daytime functional loss subscale points. Conclusion : The results of the study showed that in patients with cervical disc hernia, sleep quality and daytime functionality were negatively affected by severity of pain that limited daily activities. Bringing the pain under control with surgical treatment was observed to increase sleep quality. It can be concluded that when planning treatment for these patients, it should be taken into consideration that there could be a sleep disorder in addition to the complaints and symptoms such as pain, hypoestesia and loss of strength.

• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.419-422
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• 2010

Objective : To analyze the clinical outcomes of computed tomography (CT) fluoroscopy-guided selective neve root block (SNRB) for severe arm pain caused by acute cervical disc herniation. Methods : The authors analyzed the data obtained from 25 consecutive patients who underwent CT fluoroscopy-guided SNRB for severe arm pain, i.e., a visual analogue scale (VAS) score of 8 points or more, caused by acute soft cervical disc herniation. Patients with chronic arm pain, motor weakness, and/or hard disc herniation were excluded. Results : The series comprised 19 men and 6 women whose mean age was 48.1 years (range 35-72 years). The mean symptom duration was 17.5 days (range 4-56 days) and the treated level was at C5-6 in 13 patients, C6-7 in 9, and both C5-6 and C6-7 in 3. Twenty-three patients underwent SNRB in 1 session and 2 underwent the procedure in 2 sessions. No complications related to the procedures occurred. At a mean follow-up duration of 11.5 months (range 6-22 months), the mean VAS score and NDI significantly improved from 9 and 58.2 to 3.4 and 28.1, respectively. Eighteen out of 25 patients (72%) showed successful clinical results. Seven patients (28%) did not improve after the procedure, and 5 of these 7 underwent subsequent anterior cervical discectomy and fusion. Conclusion : CT fluoroscopy-guided SNRB may play a role as a primary conservative treatment for severe arm pain caused by acute cervical disc herniation.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.1042-1046
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• 2001

The incidence of paraplegia following drain of cerebrospinal fluid(CSF) by lumbar puncure below a spinal block is rare, and most of them occurred in spinal tumor. We report a case of acute paraplegia following lumbar puncture for computed tomography myelography(CTM) in a 42-year-old man who sustained a cervical disc herniation. Four hours after lumbar puncture for CTM, sudden paraplegia was developed. After emergent anterior cervical discectomy and fusion with cervical plating, the patient recovered completely. To the authors' knowledge, this is the first case of spinal shock complicating lumbar puncture for routine myelography in a patient with cervical disc herniation. The prompt recognition of this unusual complication of lumbar puncture may lead to good clinical outcome. Instead of CTM requiring lumbar puncture, MRI should be considered as the initial diagnostic procedure in a patient of cervical disc herniation associated with myelopathy. We discuss the possible mechanisms of acute paraplegia following lumbar puncture with literature review.